Question

Jennifer Hoffman
Scenario Details:
Patient data: Female – Age 33 years. Weight 99 pounds (45 kg). Height 61 inches (1.55 meter)
Allergies: Seasonal allergic rhinitis
Prior Medical History: History of asthma since childhood with multiple emergency visits within the past year. Medications used at home include beclomethasone dipropionate (Qvar), salmeterol xinafoate inhaled (Serevent), and albuterol sulfate (ProAir) inhaler.
Recent Medical History: Jennifer Hoffman is a 33-year-
old female brought to the Emergency Department by her
neighbor. She has a history of asthma since childhood with multiple emergency visits within the last year. She appears to be in respiratory distress, struggling to breathe. She is unable to speak other than simple one-word statements.
Primary Medical Diagnosis: Acute Severe Asthma Provider’s Orders:
Advanced Care Planning
 Goals of Care Designation – R1, Designation Definition: Patient is expected to benefit from and is accepting of any appropriate investigations/ interventions that can be offered including attempted resuscitation and ICU care.
Medication and IV’s
 IV normal saline at 150 mL/hour
 Albuterol 2.5 mg every 20 minutes × 3 doses
 Ipratropium 500 mcg QID
Respiratory Care
 O2 therapy – Titrate to Saturation – Oxygen to maintain SpO2 greater than 92%
Patient Care
 Vital signs every 30 min
 Continuous SP02 monitoring
  

Simulation Preparation Questions:

5. Identify orders and equipment required to administer oxygen therapy to Jennifer. Research the following oxygen delivery equipment, what each are used for and in what situation each should be used.

o Nasal cannula
o Simple face mask
o Rebreather/non rebreather mask o Venturimask
o Highflowtubingequipment

6. Identify information to be reported and documented regarding the administration of oxygen therapy to Jennifer.

7. Outline the steps required to safely administer a medication via nebulizer to Jennifer, consider safety, the nursing process, and patient teaching required in this scenario.

8. Describe the comfort and safety factors to consider when caring for Jennifer holistically as she experiences a severe acute asthma attack.

9. List criteria for evaluating the effectiveness of the interventions ordered for Jennifer, such as oxygen therapy and/or inhalant medications.

Answer 1

5.

Equipment required: oxygen mask, humidifier, sterile water.

6. The patient's respiratory rate, use of accessory muscles of respiration, SpO₂ before and after administering oxygen.

7.

a. Identify the patient and verify the orders.

b. Explain the procedure and the need for nebulization to the patient.

c. Assemble all the articles required to administer nebulization at the patient's bedside.

• Nebulizer
• Nebulization mask
• Medication
• Normal Saline: Helps in proper absorption of the medication
• Syringe: To instill the medication and normal saline inside the nebulization set
• Tissues: To wipe the face after administration of nebulization.

d. Wash hands.

e. Connect the nebulization mask into the nebulizer.

f. Instill the medication and normal saline into the medication chamber of the mask as per the dose ordered.

g. Apply the mask over the patient's face and adjust it so that it fits snugly.

h. Ask the patient to take deep breaths during nebulization.

i. Switch on the nebulizer.

j. After the medication is completed switch off the nebulizer, wipe the patient's face and record it in the nurses notes. Document the patient's response to the procedure. Aftercare of the articles used.

8.

• Provide a comfortable position to the patient: Fowler's position, provide a cardiac table with pillows on it so that the patient can rest in that position.
• Put side rails.
• Provide a calm and quiet environment
• Do not disturb the client unnecessarily.

9.

• Respiratory rate: between 16 to 24 breaths/ min
• No use of accessory muscles of respiration.
• SpO2 between 92 to 100 %.
• The patient verbalizes comfort/ no distress in breathing.
• Absence of wheeze on auscultation